From NYT "The Hidden Costs of Medical Student Debt" By By PAULINE W. CHEN, M.D. An Excerpt

For almost three generations, debt has been a nearly inescapable part of becoming a doctor. Over 80 percent of each medical student class will graduate in debt; and while that percentage has remained unchanged for 25 years, the increase in the total amount owed has leapfrogged over all other economic reality checks, like inflation and the consumer price index. According to the Association of American Medical Colleges, which has been trying to address the problem for nearly a decade, young doctors who graduated from medical school last year had an average debt of $158,000, or $2.3 billion for the group as a whole. Almost a third of students owed more than $200,000, a number that will only increase with the addition of interest over payback periods of 25 to 30 years.

The skyrocketing costs are primarily due to the expansion and increasing complexity of universities and academic medical centers, and to the trend among university administrators to use tuition to support institutional projects that may be only indirectly linked to medical student education.
But while upgraded clinical facilities and spectacular research programs are obvious reasons, another key factor has gone largely unnoticed. It is our society’s assumption that individual indebtedness is required to obtain big-ticket items, whether they are cars, houses or higher education.
“It’s become normal now to take out loans to get anything of value,” said Dr. S. Ryan Greysen, an assistant professor of medicine at the University of California, San Francisco, and lead author of a fascinating study published this month on the historical and social factors that have contributed to rising medical student indebtedness. “Getting a medical education has become similar to getting a mortgage on your house.”

The acceptance of student indebtedness as the “norm” of medical school has provided a kind of carte blanche for robust tuition increases. Median yearly tuition at public medical schools is $29,000, and at private institutions it is $47,000 — increases from two decades earlier of over 312 percent and 165 percent, respectively. While some may counter that future doctors can well afford such increases and loans, the rising debt load has had and will have repercussions on patients, particularly those in greatest need.

Paying so much up front has transformed an education that was once a path to public service into a significant financial investment that needs to yield returns. “Because of all the debt, people stop thinking of medicine as an incredible opportunity to do good,” Dr. Greysen said. For some young people, looming debts mean eschewing a calling to serve a particularly needy, less lucrative patient population or practice, and instead pursuing a well-compensated subspecialty that caters to the comfortably insured.